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Invasive aspergillosis in leukemic children
T Shitara1, S Yugami, M Sotomatu
1Department of Pediatrics, Gunma University School of Medicine, Japan.
Abstract:
Two cases of invasive aspergillosis are reported. Case 1, a 3-year-old boy with leukemic transformation of myelodysplastic syndrome, had an aspergillus infection in the hand, resulting in necrosis of the thumb. Case 2, an 18-year-old girl with acute megakaryoblastic leukemia, had an aspergillus skin infection on the wrist, accompanied by swelling and discoloration of the arm. In Case 2, angiography revealed a hypovascular lesion and vascular irregularity, suggesting that vessels were involved. Intraarterial infusion of urokinase and amphotericin B led to improvement of these symptoms in this patient. The combination of urokinase and an antifungal drug should be considered for intractable aspergillus infections involving the extremities.
Insights
Invasive aspergillosis can affect extremities, causing necrosis. Combining urokinase with antifungal drugs may treat severe cases, particularly in immunocompromised patients.
Area of Science:
- Medicine
- Infectious Diseases
- Hematology
Background:
- Invasive aspergillosis is a serious fungal infection, often occurring in immunocompromised individuals.
- Extremity involvement in invasive aspergillosis is rare but can lead to severe complications.
Observation:
- Two cases of invasive aspergillosis in pediatric and young adult patients with hematologic malignancies are presented.
- Case 1: A 3-year-old boy with myelodysplastic syndrome developed thumb necrosis due to Aspergillus infection.
- Case 2: An 18-year-old female with acute megakaryoblastic leukemia experienced an Aspergillus skin infection on the wrist, with vascular complications.
Findings:
- Angiography in Case 2 revealed vascular irregularities, indicating vessel involvement.
- Intraarterial infusion of urokinase and amphotericin B improved symptoms in Case 2.
- The study highlights the potential for Aspergillus to cause severe extremity infections in leukemia patients.
Implications:
- The combination of urokinase and antifungal therapy should be considered for intractable Aspergillus infections of the extremities.
- Early recognition and aggressive treatment are crucial for managing invasive aspergillosis in immunocompromised patients.
- This approach may improve outcomes for limb-threatening fungal infections.